Does Blue Cross Blue Shield of Illinois Cover Phendimetrazine

Explore coverage of Phendimetrazine by Blue Cross Blue Shield of Illinois, potential cost without insurance, and tips to secure coverage.
Curex allergy drops unboxing
“Curex is changing the landscape of allergies in 2024”
man opening Curex packaging
man opening Curex packaging

 

Coverage for Phendimetrazine

 

  • Blue Cross Blue Shield of Illinois may cover Phendimetrazine under specific circumstances, typically related to obesity treatment where conventional methods have not been effective.
  •  

  • Coverage often requires pre-authorization, so it's essential to consult with your healthcare provider to discuss eligibility.

 

Criteria for Coverage

 

  • Patients must usually demonstrate a need for medical weight loss intervention, which might involve a body mass index (BMI) above a certain threshold.
  •  

  • Previous documented attempts at weight reduction through diet and exercise are generally required.

 

Basic Rules

 

  • Treatment with Phendimetrazine must align with the patient-specific plan prescribed by a healthcare professional.
  •  

  • Check your specific plan document as coverage and requirements can vary based on the individual policy.
  •  

  • It's crucial to verify with Blue Cross Blue Shield of Illinois directly to ensure coverage specifics are understood.

 

Want to try immunotherapy?

Start with Curex

Covered

Uncovered

Treat your allergies with Curex - $49  $9.99

Review your allergy test results with a Curex allergist.

Our team is here to help!

Dr. Neeta Ogden, MD

Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

Dr. Ravi Patel, VP Telemedicine

At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

Jill Hamburg, PA - C

Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How to Get Phendimetrazine Coverage with Blue Cross Blue Shield of Illinois

 

Review Your Prescription Drug Benefits

 

  • Log in to your Blue Cross Blue Shield of Illinois (BCBSIL) online account through their portal or mobile app.
  •  

  • Access the prescription drug coverage section to verify if Phendimetrazine is included in your plan's formulary.
  •  

  • Check if the medication is covered under your specific plan tier and understand any co-pays or limitations.

 

Consult with Your Healthcare Provider

 

  • Discuss with your physician the need for Phendimetrazine, ensuring it is medically necessary for your condition.
  •  

  • Request any necessary documentation or a letter of medical necessity that BCBSIL might require for coverage.

 

Reach Out to BCBSIL Customer Service

 

  • Contact BCBSIL's customer service number found on your insurance card to inquire about Phendimetrazine coverage details.
  •  

  • Ask if any prior authorization is needed for Phendimetrazine and understand the steps involved if it is required.

 

Submit a Prior Authorization Request

 

  • Work with your healthcare provider to submit a prior authorization request if Phendimetrazine necessitates approval before being covered.
  •  

  • Ensure all necessary medical documentation accompanies the prior authorization to improve the likelihood of approval.

 

Appeal Denials if Necessary

 

  • If BCBSIL denies coverage, review their provided reason and gather additional supporting documentation if applicable.
  •  

  • Submit an appeal through BCBSIL’s official process, providing a strong justification for the necessity of Phendimetrazine.

 

Review Alternative Coverage Options

 

  • Explore alternative weight loss medications covered by BCBSIL if Phendimetrazine is consistently denied or not covered.
  •  

  • Discuss these alternatives with your healthcare provider to ensure they are a suitable replacement.

 

Curex allergy drops unboxing

We love helping people!

Allie, Nevada

five stars

"I have two cats I can finally cuddle!"

Cat and dog allergies

Zachary, Texas

five stars

“I can breathe through my nose for the first time in like 20 years!"

dust allergy
mold allergy

Dust and mold allergies

Erika, New York

five stars

“I've noticed less sneezing and shortness of breath.”

tree allergy
grass allergy

Tree and grass allergies

Richard, Texas

five stars


I love the convenience!

tree allergy

Tree and cat allergies

We Treat Food, Indoor & Outdoor Allergies

tree allergy
Tree Pollens
maple leaf icon
Weed Pollens
Cat Allergies
Dog Allergies
insect icon
Dust Mites
mold allergy
Molds
Food Allergies
 curex user showing allergy treatment kita patient showing allergy treatment boxa male patient showing allergy drops vial
50,000+ users have overcome their allergies
Am I eligible?

Benefits of Curex

At-home treatment

Apply treatments in minutes from the comfort of your own home with under-the-tongue applications instead of shots or pills

5-30x higher cumulative dose vs allergy shots

Sublingual immunotherapy delivers a higher dose of allergens over the course of treatment.

Potential for results in as few as 6 months

Individual results vary but some users have reported a noticeable difference in as few as 6-12 months since starting treatments

Excellent safety profile

Studies that have been reviewed by certified physicians show that sublingual immunotherapy is a safe treatment option
male medical practitioner smiling

Treatment prescribed
by clinician

1
right line icon
Curex packaging

Clinicaly made allergen extracts are customized for your allergies

2
right line icon
insect icon
grass icon
man opening Curex packaging

Your immune system gets desensitized to allergens, giving you long-term relief.

3

FAQs

Does Blue Cross Blue Shield of Illinois Cover Phendimetrazine

Explore coverage of Phendimetrazine by Blue Cross Blue Shield of Illinois, potential cost without insurance, and tips to secure coverage.
Curex allergy drops unboxing

Is Phendimetrazine Covered by Blue Cross Blue Shield of Illinois

 

Coverage for Phendimetrazine

 

  • Blue Cross Blue Shield of Illinois may cover Phendimetrazine under specific circumstances, typically related to obesity treatment where conventional methods have not been effective.
  •  

  • Coverage often requires pre-authorization, so it's essential to consult with your healthcare provider to discuss eligibility.

 

Criteria for Coverage

 

  • Patients must usually demonstrate a need for medical weight loss intervention, which might involve a body mass index (BMI) above a certain threshold.
  •  

  • Previous documented attempts at weight reduction through diet and exercise are generally required.

 

Basic Rules

 

  • Treatment with Phendimetrazine must align with the patient-specific plan prescribed by a healthcare professional.
  •  

  • Check your specific plan document as coverage and requirements can vary based on the individual policy.
  •  

  • It's crucial to verify with Blue Cross Blue Shield of Illinois directly to ensure coverage specifics are understood.

 

A weight management program tailored to you

Start with Curex

Blue Cross Blue Shield of Illinois's Approved Criteria for Phendimetrazine Coverage

 

<b>Eligibility Criteria for Phendimetrazine Coverage</b>

&nbsp;

<ul>

<li>The patient must have a documented diagnosis of obesity. For the purposes of coverage, obesity is defined as a Body Mass Index (BMI) of 30 kg/m² or greater.</li>

&nbsp;

<li>If the patient's BMI is between 27 kg/m² and 29.9 kg/m², Phendimetrazine may be covered if the patient has at least one weight-related comorbidity, such as hypertension, type 2 diabetes, or dyslipidemia.</li>

&nbsp;

<li>Physician documentation must indicate that the patient has attempted weight loss through diet and exercise alone, but these methods were not sufficient for weight management.</li>

&nbsp;

</ul>

&nbsp;

<b>Required Supportive Information</b>

&nbsp;

<ul>

<li>Recent progress notes indicate a comprehensive weight management plan, including lifestyle interventions such as dietary changes and increased physical activity.</li>

&nbsp;

<li>Clinical documentation should support the necessity of pharmacological intervention as part of the weight loss plan.</li>

&nbsp;

<li>Evidence of routine follow-up to assess the effectiveness and safety of the treatment, such as regular weight monitoring and evaluation of any potential side effects, should be included in the patient's medical records.</li>

&nbsp;

</ul>

&nbsp;

<b>Continuation of Therapy Criteria</b>

&nbsp;

<ul>

<li>Demonstrated progress in weight loss from baseline measurements after an initial period of 12 weeks on Phendimetrazine.</li>

&nbsp;

<li>Continued coverage is contingent upon the patient achieving a clinically meaningful weight loss, typically defined as a 5% reduction of initial body weight, unless other clinical circumstances justify continuation.</li>

&nbsp;

<li>Ongoing assessment of the treatment’s efficacy and safety by a healthcare provider, ensuring no contraindications to continued use, is required.</li>

&nbsp;

</ul>

&nbsp;

Why Blue Cross Blue Shield of Illinois Might Deny Phendimetrazine Coverage

 

Reasons for Denial of Phendimetrazine Coverage

 

  • Phendimetrazine is not covered when used for purposes other than those approved by the FDA. This includes off-label uses that do not align with the drug's intended purpose, such as unapproved conditions related to weight loss.
  •  

  • Coverage may be denied if the prescribed dosage or duration does not comply with BCBSIL's pharmacy guidelines. This includes scenarios where usage exceeds the recommended limits without medical justification.
  •  

  • If the patient does not meet the necessary medical criteria outlined by Blue Cross Blue Shield of Illinois for obesity treatment, coverage will not be provided. For instance, this could involve not meeting the required Body Mass Index (BMI) threshold.
  •  

  • Claims for Phendimetrazine may be denied if pre-authorization was not obtained, where such authorization is required. This affects prescriptions that bypass necessary prior approval processes.
  •  

  • Coverage is not granted if there is a history of substance abuse or addiction identified in the patient's health records, as Phendimetrazine is a controlled substance with potential abuse risks.
  •  

  • Phendimetrazine is not covered when used in combination with other weight-loss medications, especially if this combination increases health risks or is considered experimental without evidence of efficacy and safety.
  •  

 

Together with our partners we have changed the lives of over 300,000 patients.

How Much Does Phendimetrazine Cost without Insurance?

 

Approximate Cost of Phendimetrazine Without Insurance

 

  • The price of Phendimetrazine without insurance can vary significantly depending on the pharmacy and location. On average, the cost for 100 tablets of the 35 mg strength typically ranges from $20 to $40.
  •  

  • Pricing may be different at various pharmacy chains, with some offering discount programs or membership cards that can further reduce the out-of-pocket cost.
  •  

  • Online pharmacies might offer competitive prices, but it is crucial to ensure they are legitimate and require a valid prescription.
  •  

  • For those paying out-of-pocket, using discount cards such as those offered by GoodRx can potentially decrease the price, often bringing it down to the lower end of the cost range.

 

Factors Affecting Price

 

  • **Location**: Prices may differ based on geographic region and the availability of the drug.
  •  

  • **Quantity**: Buying in larger quantities may reduce the price per pill compared to smaller prescriptions.
  •  

  • **Pharmacy**: Brand versus generic versions and different pharmacy pricing strategies impact final cost.
  •  

  • **Discount Programs**: Enrollment in pharmacy savings programs can lower prices if insurance is not being utilized.

 

Conclusion

 

  • The cost of Phendimetrazine can be managed through careful comparison shopping and by leveraging available discounts and rebate programs.
  •  

  • Consult with your healthcare provider or pharmacist for more personalized advice on reducing costs and ensuring safe usage.

 

Our team is here to help!

Dr. Neeta Ogden, MD

Curex is poised to revolutionize the way allergies are treated in America, expanding access to clinical care and treatments that can meaningfully improve patients quality of life.

Dr. Ravi Patel, VP Telemedicine

At Curex, our mission is to help people improve their health and quality of life by understanding their allergies and treating them at their source.We provide more than individualized prescription treatments; we provide individualized care.

Jill Hamburg, PA - C

Immunotherapy made simple.  We enable patients to receive personalized allergy care on their own time. No more waiting rooms.

Dr. Chet Tharpe, Medical Director

Curex has set the standard for the virtual allergy experience. From the comfort of their home, patients nationwide are able to receive a personalized treatment plan from an experienced clinician, aimed at treating the source of their allergies, not just the symptoms.

Kayla Mardaga, NP

Curex offers convenient at-home allergy testing options. Our goal is to determine if a patient would benefit from immunotherapy and then customize a treatment plan that can reduce both the symptoms and the reliance on allergy medications.

How to Get Phendimetrazine Coverage with Blue Cross Blue Shield of Illinois

 

Review Your Prescription Drug Benefits

 

  • Log in to your Blue Cross Blue Shield of Illinois (BCBSIL) online account through their portal or mobile app.
  •  

  • Access the prescription drug coverage section to verify if Phendimetrazine is included in your plan's formulary.
  •  

  • Check if the medication is covered under your specific plan tier and understand any co-pays or limitations.

 

Consult with Your Healthcare Provider

 

  • Discuss with your physician the need for Phendimetrazine, ensuring it is medically necessary for your condition.
  •  

  • Request any necessary documentation or a letter of medical necessity that BCBSIL might require for coverage.

 

Reach Out to BCBSIL Customer Service

 

  • Contact BCBSIL's customer service number found on your insurance card to inquire about Phendimetrazine coverage details.
  •  

  • Ask if any prior authorization is needed for Phendimetrazine and understand the steps involved if it is required.

 

Submit a Prior Authorization Request

 

  • Work with your healthcare provider to submit a prior authorization request if Phendimetrazine necessitates approval before being covered.
  •  

  • Ensure all necessary medical documentation accompanies the prior authorization to improve the likelihood of approval.

 

Appeal Denials if Necessary

 

  • If BCBSIL denies coverage, review their provided reason and gather additional supporting documentation if applicable.
  •  

  • Submit an appeal through BCBSIL’s official process, providing a strong justification for the necessity of Phendimetrazine.

 

Review Alternative Coverage Options

 

  • Explore alternative weight loss medications covered by BCBSIL if Phendimetrazine is consistently denied or not covered.
  •  

  • Discuss these alternatives with your healthcare provider to ensure they are a suitable replacement.

 

Premium Medication you can trust

Our weight loss medication is delivered straight to your doorstep from a state-licensed pharmacy within our reliable network, ensuring you receive your medication when you need it.

Each pharmacy in our network undergoes rigorous third-party testing through FDA and DEA certified labs. These tests focus on four key elements, ensuring both safety and efficacy for our treatments.

Phendimetrazine FAQ

1. What are the common side effects of Phendimetrazine?

 

Common Side Effects of Phendimetrazine

 

  • Increased heart rate: Users may experience a faster heart rate, leading to palpitations.
  •  

  • Elevated blood pressure: Monitoring blood pressure is advised due to potential increases.
  •  

  • Insomnia: Difficulty sleeping can occur, particularly if taken later in the day.
  •  

  • Nervousness: Feelings of anxiousness or restlessness are possible side effects.
  •  

  • Dizziness: Some users may experience lightheadedness or dizziness.
  •  

  • Dry mouth: A common side effect, leading to increased thirst.
  •  

  • Stomach upset: Nausea or constipation might affect some individuals.
  •  

  • Headache: Mild to moderate headaches can occur.

 

2. How does Phendimetrazine help with weight loss?

 

How Phendimetrazine Aids Weight Loss

 

  • **Appetite Suppression:** Phendimetrazine works by stimulating the central nervous system, which increases heart rate and blood pressure while reducing appetite.
  •  

  • **Energy Boost:** It helps increase energy levels, encouraging more activity and exercise, which can enhance calorie burning.
  •  

  • **Short-Term Solution:** Typically prescribed as a short-term supplement to diet and exercise. Effective for initial weight loss jumpstart.
  •  

  • **Side Effects:** Possible side effects include insomnia, dry mouth, and increased heart rate. Consultation with healthcare providers is recommended.

3. Is Phendimetrazine the same as Adipex or phentermine?

 

Are Phendimetrazine and Adipex the Same?

 

  • Different Active Ingredients: Phendimetrazine and Adipex (phentermine) contain different active ingredients. Phendimetrazine is a sympathomimetic amine, while Adipex contains phentermine, another type of appetite suppressant.
  •  

  • Similar Mechanism of Action: Both work similarly by stimulating the central nervous system to suppress appetite, helping in weight loss when combined with diet and exercise.
  •  

  • Prescription Differences: Both are prescription medications, but doctors may choose one over the other based on patient-specific factors, including health history and weight loss goals.
  •  

  • Consult Your Doctor: It's important to consult your healthcare provider to determine which medication is appropriate for your needs.

 

Have questions left?

Get a personalized online consultation with a doctor at Curex

Curex is one of America’s largest telehealth providers

Together with our partners we have changed the lives of over 300,000 patients. Here’s what some of them have to say:

“Curex has performed beyond my expectations. I am feeling tremendously better and look forward to continuing the treatment.”
Becky D.
"If I could give 6 stars, I would. BEST... BEST… BEST… service.”
Ferdian K.
“The Curex staff has been professional, efficient, and really focused on my individual needs.”
Ana C.

Start your
journey now

Everything you need is included:

Online consultation

Your prescription

Premium medication

Overnight shipping

Ongoing support

A weight management program tailored to you

Initial Dosage

Your initial medication and dosage are carefully determined by doctors, taking into account your unique health profile. This ensures a personalized and safe treatment plan tailored to your specific needs.

Titration

We gradually adjust your dosage to reach the optimal therapeutic level, ensuring maximum effectiveness while minimizing potential side effects.

Additional Treatments

Our providers may also recommend medications such as metformin or supplements such as vitamin B12. We recognize the importance of managing side effects, so your care plan may include medication to alleviate them.

Got questions? We have answers.

Do your plans include prescriptions and medications?

Curex plans cover everything from reviewing your medical intake to providing prescription medications, with free shipping included. There are no extra or hidden charges. Prescriptions are issued only after a medical provider reviews your information to confirm that the medication is suitable for you. Our service includes continuous support and regular follow-ups to ensure your treatment stays on track.

Our clinicians may order labs and additional medications for you, which would not be covered by the plan but for which you can use your insurance.

Please note: Compounded medications are tailored to individual needs or used in case of shortages, but they are not FDA-approved for safety or effectiveness. A prescription is required. Results may vary from person to person.

What medications do your providers prescribe?

We prioritize a personalized approach to your health. If your medical provider prescribes medication, options may include GLP-1 treatments such as compounded semaglutide (the active ingredient in Wegovy®* and Ozempic®*). Our providers prescribe only combination treatments not available at your local pharmacy that may include vitamin B12, etc. to help you achieve your goals faster.

Depending on your treatment goals, other medications such as metformin may also be considered. We recognize the importance of managing side effects, so your care plan might include medication to ease symptoms like nausea. Your well-being is always our top priority!

Please note that compounded medications are customized to meet individual patient needs and are not FDA-approved for safety or effectiveness. A prescription is necessary. Results may vary from person to person.

Curex and its pharmacy partners do not have any association with Novo Nordisk.

Will I be prescribed semaglutide if I sign up?

Your health journey is unique, and we tailor our care to match. Any prescriptions, including semaglutide, will be based on the expert assessment of the medical provider matched with you through our platform. You can trust that your treatment plan will be personalized to fit your specific needs. And if semaglutide is not prescribed, we will provide a full refund.

What is compounded medication?

Compounding involves creating customized medications to meet the specific needs of individual patients. For instance, a patient may require a liquid version of a medication that is only available in tablet form. Pharmacies can also compound medications using FDA-approved drugs that are on the FDA’s shortage list.

These compounded medications are made by state-licensed pharmacies that follow both federal and state regulations, including quality standards. However, when compounded in accordance with these laws, these medications are not subject to FDA approval and are not evaluated for safety or effectiveness.

Is compounded medication the same as generic medication?

Compounded medications differ from generic drugs. Generics require FDA approval by demonstrating bio-equivalence to the brand-name drug. In contrast, compounded medications are not FDA-approved. They are made based on a personalized prescription that may not be commercially available elsewhere or when a drug appears on the FDA’s shortage list. Compounding pharmacies must have the proper licensed facilities and comply with state and federal regulations before dispensing these medications.

Is insurance required?

No, Curex doesn’t require insurance. We offer clear and simple pricing, along with affordable medication options, making it easy and accessible to take care of your health.

Can I pay with an FSA or HSA card?

Yes! You can pay with your HSA or FSA card.

How much does treatment cost?

Semaglutide Injections:

Prices for semaglutide start at only $149 per month for weekly doses of 0.25mg and 0.5mg. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 1mg, 1.7mg and 2.4mg of semaglutide for an additional $50 per month for each plan.

Tirzepatide Injections:

Prices for tirzepatide start at only $249 per month for weekly doses of 2.5mg and 5mg of tirzepatide.You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 7.5mg, 10mg and 12.5mg of tirzepatide for an additional $100 per month for each plan.

Semaglutide Tablets:

Prices for semaglutide tablets start at only $149 per month for daily doses of 2mg. You can cancel anytime. Some people experience weight loss at this dose and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 4mg and 8mg of semaglutide daily for an additional $50 per month for each plan.

Tirzepatide Tablets:

Prices for tirzepatide start at only $199 per month for daily dosees of 3mg of tirzepatide. You can cancel anytime. Some people experience weight loss at these doses and higher doses aren't advisable due to a higher risk of side effects. If you need a higher dose to achieve your weight loss goals, we offer higher-dose plans for 6mg and 12 mg of tirzepatide daily for an additional $100 per month for each plan.

Can you prescribe Ozempic®* or Wegovy®*?

Our providers focus on personalized medications and dosages that aren’t commercially available at your local pharmacy. While we don’t prescribe Ozempic®* or Wegovy®* directly, we may prescribe treatments containing the same active ingredient. These medications are specially compounded for you by a licensed pharmacy to meet your specific needs.

Are video visits with a provider required?

Our providers will review your information 100% online. Depending on where you live and the specifics of your medical history, our providers may require you to have a video visit or asynchronous visit via text message. If prescribed, you’ll get unlimited online access to message your provider as needed for follow-ups, adjustments, and answers to your questions.

What states do you serve?

Currently, we do not serve Arkansas, Connecticut, and New Mexico. However, we are always working to expand our reach, so stay in touch with us at hi@getcurex.com.

Made in Webflow